scholarly journals ABORDAGEM TERAPEUTICA DE ABSCESSOS CEREBRAIS MÚLTIPLOS DE CAUSA IDIOPÁTICA EM PACIENTE IMUNOCOMPETENTE: RELATO DE CASO.

2018 ◽  
Vol 5 (4) ◽  
pp. 23-27
Author(s):  
Ermilton Barreira Parente Júnior ◽  
Marlon Daniel Gomes Coelho ◽  
Thais Mahassem Cavalcante de Macedo Parente ◽  
Olivia Maria Veloso Coutinho ◽  
Oscar Nunes Alves
Keyword(s):  
Antibiotic Therapy ◽  
Rare Case ◽  
Mass Effect ◽  
Immunocompetent Patient ◽  
Etiologic Agent ◽  
Evolutionary Stage ◽  
Temporal Region ◽  
Empirical Antibiotic Therapy ◽  
Brain Abscesses ◽  
The Right

Introdução: Abscessos cerebrais múltiplos são focos de infecções piogênicas do parênquima cerebral que requerem uma atenção imediata e eficaz para reducão de morbimortalidade. A identificação do agente etiológico e do foco infeccioso normalmente é de grande valia na programação terapêutica. Esse trabalho busca relatar um raro caso de abscessos cerebrais múltiplos em paciente imunocompetente e sem fatores de risco evidentes, e o papel fundamental da antibioticoterapia empírica na resolução do caso. Relato do caso: Paciente, 75 anos, sem evidência de imunossupressão e doenças prévias iniciou quadro de alterações das atividades básicas da vida diária, confusão de tempo e espaço, hipersonia, lentificação da marcha, disartria e dor em pontada na região temporal direita que não cessava ao uso de analgésicos. Em Ressôncia magnética evidenciou-se múltiplos abscessos em região temporal gerando efeito de massa e hipertensão intracraniana. Realizado craniotomias com drenagens de secreções purulentas e culturas do material que não identificaram o agente etiológico. Discussão: A abordagem terapêutica dos abscessos cerebrais ainda não se encontra definida. Em virtude disso, cada caso tem sido conduzido de forma individualizada de acordo com a localização das lesões, seu estágio evolutivo e as condições clínicas do paciente. No caso em questão não indentificou-se a origem dos abscessos e a resolução do quadro foi obtida através das drenagens cirúrgicas em associação a antibioticoterapia empírica. Com os avanços da neuroimagem e da farmacologia, a redução da mortalidade por abscessos cerebrais reduziu para menos de 10%. Porém, a não identificação de um agente etiológico e diversas abordagens neurocirúrgicas podem acarretar em mais comorbidades para o paciente. Apresentamos um raro caso de abcessos cerebrais em paciente imunocompetente sem identificação de organismo agressor e o papel da antibioticoterapia empírica na resolução do caso.   Palavras-chave: abscesso encefálico; imunocompetência; diagnóstico;  terapêutica; antimicrobianos. ABSTRACT Introduction: Multiple brain abscesses are centers of pyogenic cerebral parenchymal infections that require immediate and effective attention to reduce morbidity and mortality. The identification of the etiologic agent and the infectious focus are usually of great value in terms of therapeutic planning. This paper seeks to report a rare case of multiple brain abscesses in an immunocompetent patient with no evident risk factors and the fundamental role that empirical antibiotic therapy plays in the resolution of the case. Case report: A 75-year-old patient with no evidence of immunosuppression and previous illnesses began to experience changes in her basic daily live activities, confusion in time and space, hypersomnia, gait slowing, dysarthria and stabbing pain in the right temporal region of the brain that would not cease even with use of analgesics. Magnetic Resonance revealed multiple abscesses in the temporal region generating mass effect and intracranial hypertension. It was performed craniotomies with drainage of purulent secretions and it was prepared cultures out of the material which resulted in no identification of the etiological agent. Discussion: The therapeutic approach of brain abscesses has not yet been defined. As a result, each case has been conducted in an individualized manner according to the location of the lesions, their evolutionary stage and the patient's clinical conditions. In the case of this report, the abscess’ origin was not identified and the resolution of the condition was obtained through surgical drainage in association with empirical antibiotic therapy. With advances in neuroimaging and pharmacology, reduction in mortality from brain abscesses reduced to less than 10%. However, failure to identify an etiologic agent and several neurosurgical approaches may lead to more comorbidities for the patient. We present a rare case of cerebral abscesses in an immunocompetent patient without identification of an aggressor organism and the importance of empirical antibiotic therapy in the resolution of the case. Keywords: brain abscess; immunocompetence; diagnosis; therapeutics; anti-infective agents.

scholarly journals Lung Abscess With Metastatic Brain Abscesses (MBA) Due to Steptococcus Anginosus (SA) in an Immunocompetent Patient: A Rare Case Report

CHEST Journal ◽  
2016 ◽  
Vol 150 (4) ◽  
pp. 187A
Author(s):  
Ahad Ayaz ◽  
Chintan Desai ◽  
Siddique Chaudhary ◽  
John Youssef ◽  
Susan Smith
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Immunocompetent Patient ◽  
Lung Abscess ◽  
Rare Case Report ◽  
Brain Abscesses

scholarly journals U.S. Case Report of Cerebral Phaeohyphomycosis Caused by Ramichloridium obovoideum (R. mackenziei): Criteria for Identification, Therapy, and Review of Other Known Dematiaceous Neurotropic Taxa

1998 ◽  
Vol 36 (3) ◽  
pp. 708-715 ◽  
Author(s):  
Deanna A. Sutton ◽  
Malcolm Slifkin ◽  
Robert Yakulis ◽  
Michael G. Rinaldi
Keyword(s):  
Middle East ◽  
Signs And Symptoms ◽  
Excisional Biopsy ◽  
Mass Effect ◽  
The United States ◽  
Subcortical Region ◽  
Clinical Mycology ◽  
History Of ◽  
Brain Abscesses ◽  
The Right

We report a case of cerebral phaeohyphomycosis in a 36-year-old male caused by the neurotropic fungus Ramichloridium obovoideum (Matushima) de Hoog 1977 (Ramichloridium mackenziei Campbell et Al-Hedaithy 1993). This man resided in the Middle East, where the fungus appears to be endemic and, possibly, geographically restricted, since all previous reports of brain abscesses due to this organism have been for patients indigenous to this area. As a servant of the Saudi Arabian royal family, he appeared in the United States seeking treatment for chronic weight loss, fatigue, decreased memory, and a more recent 2-week history of right-hand weakness which worsened to involve the entire right upper extremity. On the day prior to his admission, he had a focal motor seizure with rotation of the head and eyes to the right, followed by secondary generalization. A computerized tomogram showed a ring-enhancing hypodense lesion in the left parietal subcortical region with associated edema and mass effect. Diagnosis of a fungal etiology was made following a parietal craniotomy and excisional biopsy by observation of septate, dematiaceous hyphal elements 2 to 3 μm in width on hematoxylin-and-eosin-stained sections from within areas of inflammation and necrosis. Culture of the excised material grew out a dematiaceous mould which was subsequently identified as R. obovoideum. At two months postsurgery and with a regimen of 200 mg of itraconazole twice a day, the patient was doing well and returned to Saudi Arabia. His condition subsequently deteriorated, however, and following a 7-month course of itraconzole, he expired. We use this case to alert clinicians and personnel in clinical mycology laboratories of the pathogenicity of this organism and its potential occurrence in patients with central nervous system signs and symptoms who have resided in the Middle East and to review and/or compare R. obovoideum with other neurotropic, dematiaceous taxa and similar nonneurotropic, dematiaceous species.

scholarly journals Multiple Brain Abscesses Secondary to Odontogenic Infection: A Clinical Case Report

2021 ◽  
Author(s):  
Paulo Lucas Capelini Frisso ◽  
Richam Faissal El Hossain Ellakkis ◽  
Elton Gomes Silva ◽  
Edgar Manuel Garcete Farina ◽  
Raymond Assad El Sarraf
Keyword(s):  
Clinical Case ◽  
Brain Injuries ◽  
Etiologic Agent ◽  
Hematogenous Dissemination ◽  
Reactive Protein ◽  
Cerebral Parenchyma ◽  
Brain Abscesses ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Suppurative Infection

Abstract Introduction Cerebral abscess is a suppurative infection of the cerebral parenchyma, which may occur due to contiguity, hematogenous dissemination of distant foci, secondary to open traumatic brain injuries, or be idiopathic. Clinical Case A 63-year-old male patient sought assistance due to a severe headache in the frontal region associated with chills and lack of appetite that started four days before. Clinical examination of the patient showed no significant changes. Imaging and laboratory tests on admission showed only nonspecific changes, such as leukocytes 18,540, platelets 517,000, and c-reactive protein 2,0. In such case, magnetic resonance imaging (MRI) of the skull was performed with contrast, showing the presence of expansive lesions compatible with multiple brain abscesses in the right parieto-occipital region. Discussion After excluding the main focus of hematogenous dissemination and in view of the identification of the agent Streptococcus intermedius by means of secretion culture collected through a surgical method, the hypothesis of abscess due to contiguous dental pyogenic foci was pointed out. Conclusion Dental evaluation showed multiple foci of infection with periodontitis and dental abscess, which were treated along with the use of antibiotics directed to the etiologic agent.

scholarly journals Boxing Match Gone Awry- A Punch over the Head Leading to Eccentric Proptosis in a Child

2021 ◽  
Author(s):  
Gayathri Nithianandam ◽  
S Prabakaran ◽  
Geeta Anusha Loya ◽  
S Rajasekaran ◽  
Premnath Gnaneswaran
Keyword(s):  
Rare Case ◽  
Mass Effect ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Normal Position ◽  
Upper Eyelid ◽  
Retinal Tear ◽  
Ocular Movements ◽  
Amateur Boxing ◽  
The Right

The most common ocular pathologic conditions in amateur boxing are sub conjunctival haemorrhage, lid injuries, cataract, pupil deformation, angle abnormalities and retinal tear. Proptosis due to frontoethmoidal mucocele in young is one of the least common complications seen in boxers. Here, we discuss a rare case of unilateral eccentric proptosis of right eye in a child after he was punched over the right side of the head during a boxing match. He came with complaints of swelling of upper eyelid. Examination revealed right sided eccentric proptosis with restricted ocular movements and defective vision. Computed Tomography (CT) of orbit showed a well-defined isodense lesion with smooth margins arising from the frontal sinus, extending inferiorly to anterior ethmoidal sinus which caused mass effect over right eye and ocular muscles which resulted in displacement of the eye ball. Otolaryngologist’s opinion was obtained. Functional Endoscopic Sinus Surgery (FESS) was done. Postoperatively vision improved with no proptosis and eyeball returned to its normal position.

scholarly journals A Rare Case of Intra-Osseous Meningioma of the Sphenoid Bone - A Case Report

2013 ◽  
Vol 6 (2) ◽  
pp. 73-75
Author(s):  
Mahfuz Ara Ferdousi ◽  
Md Mofazzal Sharif ◽  
Hijbul Bahar ◽  
AS Mohiuiddin ◽  
ATM Mosharef Hossain ◽  
...  
Keyword(s):  
Rare Case ◽  
Lateral Wall ◽  
Mass Effect ◽  
Sphenoid Bone ◽  
Anterior Clinoid Process ◽  
The Right ◽  
Tuberculum Sella ◽  
Intraosseous Meningioma ◽  
The Brain ◽  
Sphenoid Ridge

A 42-year-old female patient presented with loss of vision and proptosis of her right eye. Computerized tomography (CT) scan revealed hyperostotic lesion involving the right sphenoid ridge, anterior clinoid process and roof and lateral wall of orbit with mass effect on the intraorbital contents. CT findings were suggestive of intra-osseous meningioma arising from right sphenoid bone. Later, MRI of the brain and orbit and histopathology of the lesion confirmed the case as an intra-osseous meningioma of the sphenoid bone. Though meningioma of tuberculum sella and primary calvarial meningioma were reported earlier, intraosseous meningioma of the sphenoid bone is rare. DOI: http://dx.doi.org/10.3329/imcj.v6i2.14737 Ibrahim Med. Coll. J. 2012; 6(2): 73-75

scholarly journals Relevance of empirical antibiotic treatment in the evolution of prosthetic joint infection treated with implant retention

2021 ◽  
Author(s):  
José María Barbero Allende ◽  
◽  
Marta García Sánchez ◽  
Miguel Vacas Córdoba ◽  
Eduardo Montero Ruiz ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Multidrug Resistant ◽  
Empirical Antibiotic Therapy ◽  
Empirical Antibiotic Treatment ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
The Right

Introduction. Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified. Material and methods. We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes. Results. A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01). Conclusions. Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy

scholarly journals A Rare Case of Suppurative Aspergillosis of the Thyroid

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Nikhil Dinaker Thada ◽  
Sampath Chandra Prasad ◽  
Bhasker Alva ◽  
Monika Pokharel ◽  
Kishore Chandra Prasad
Keyword(s):  
Rare Case ◽  
Hematological Malignancies ◽  
Fungal Infections ◽  
Rare Condition ◽  
Immunocompetent Patient ◽  
Subtotal Thyroidectomy ◽  
Solid Organ ◽  
Fungal Hyphae ◽  
Right Lobe ◽  
The Right

Suppurative fungal infection of the thyroid is an extremely rare condition even more so in an immunocompetent patient. Fungal infections of the thyroid usually occur in immunocompromised patients with hematological malignancies, recipients of bone marrow and solid organ allografts on immunosuppression, and patients with AIDS. A 65-year-old male presented with swelling in the front of the neck for 2 years. Examination revealed a  cm non-tender, firm swelling of the right lobe of the thyroid. The patient was taken up for a subtotal thyroidectomy. Intra-operatively, an abscess cavity with pus was found in the right lobe of the thyroid. Histopathology revealed features of fungal abscess and staining demonstrated fungal hyphae characteristic ofAspergillusssp.

scholarly journals Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 268 ◽  
Author(s):  
Aishwarya Damodaran ◽  
Anusha Rohit ◽  
Georgi Abraham ◽  
Sanjeev Nair ◽  
Anand Yuvaraj
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Renal Function ◽  
Iga Nephropathy ◽  
Rare Case ◽  
Complete Recovery ◽  
Immunocompetent Patient ◽  
Rare Occurrence ◽  
Immunosuppressive Medications ◽  
Appropriate Therapy ◽  
The Right

We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the importance of positive cultures in the choice of the appropriate therapy in an extremely rare case of an immunocompetent patient with osteomyelitis of the clavicle.

532: Empirical Antibiotic Therapy in the Management of Elevated Serum PSA- A Viable Option?

2006 ◽  
Vol 175 (4S) ◽  
pp. 172-172
Author(s):  
Chee Kwan Ng ◽  
Gerald Y. Tan ◽  
Khai Lee Toh ◽  
Sing Joo Chia ◽  
James K. Tan
Keyword(s):  
Antibiotic Therapy ◽  
Elevated Serum ◽  
Empirical Antibiotic Therapy ◽  
Viable Option

A Rare Case of Tuberculous Prostatitis

2016 ◽  
Vol 1 (2) ◽  
pp. 33
Author(s):  
Nurul Yaqeen Mohd Esa ◽  
Mohammad Hanafiah ◽  
Marymol Koshy ◽  
Hilmi Abdullah ◽  
Ahmad Izuanuddin Ismail ◽  
...  
Keyword(s):  
Rare Case ◽  
Correct Diagnosis ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Tuberculosis Infection ◽  
Advanced Age ◽  
Immunocompromised Patients ◽  
Prostatic Biopsy ◽  
High Clinical Suspicion

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

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